Posted
by
timothy
on Friday October 26, 2012 @08:09PM
from the or-do-you-prefer-it-old-school dept.

sciencehabit writes "A tonic of gut microbes may be the secret recipe for treating a common hospital scourge. Researchers have pinpointed the exact mix of microbes required to cure mice of chronic infection by Clostridium difficile. The hard-to-treat bacterium infects alomst 336,000 in the US each year and causes bloating, pain, & diarrhea. A similar bacterial cocktail may be able to replace the current controversial treatment involving the intake of a healthy person's fecal matter to restore the right balance of microbes in the gut."

It's a joke. But seriously, I work in the healthcare field and have a number of gastroenterologist friends who have told me about this therapy before. One method of administration is via a nasogastric tube and, sorry here folks, but notwithstanding the physical integrity of the tubing, just knowing that pureed shit was being pumped through my nose and down my throat would cause me some significant levels of distress (or maybe not, as it appears the C. Diff. is a really crappy illness to have, pun intended

To get an idea of how gut bacteria are that important: we are made of about 10e13 human cells, and we contain 10e14 gut bacterial, for about 2 kg of mass. Let a subset of the gut bacteria population become hostile pathogens, and you see that we can easily be outnumbered by attackers.

Just had that happen to me. Multiple infections meant that in the last six months I have had every type of antibiotic available. Then, surgery to remove the source of the infections. Since I'd been exposed to every major branch of antibiotics, the bacteria in my gut was now resistant to all but the 'drugs of last resort'. So of course, some of that bacteria got out and started trashing my insides and the surgical incision.

Scariest thing in the world to hear that the normal bacteria in your gut is now resistant to everything but Vanc, Streptomycin, and Linezolid; and that it's trying to chew it's way through your kidneys. Especially since those drugs of last resort almost all cause kidney damage.

Interesting thought, but last resort drugs seem to have worked. First time in months I haven't had a PICC line, and no sign of more drug resistant crap. But I'll keep that option in mind. Meanwhile, I'll keep daydreaming of ways that breeding resistant bacteria could give me superpowers. I'd make a good arch-nemisis.

Since I'd been exposed to every major branch of antibiotics, the bacteria in my gut was now resistant to all but the 'drugs of last resort'

Note that antibiotic resistance would not be a problem if your immune system had been able to cope with your pathogen species.

The disaster here may be caused by bacterial selection through antibiotics. In normal situations, gut bacteria fight each others near equilibrium, and your immune system just have to maintain the equilibrium by reducing species that are growing too much. Antibiotics wipe out entire chunks of gut bacteria diversity, creating situations where some resistant species do not have bacteria

The original pathogen was not a gut bacteria. It was something a bit stranger than that, which I won't go into here. Regardless, the available treatment was 2 weeks of antibiotics which, because of flaws unknown at the time, only killed the apparent infection and not the 'cyst' it was hiding in. So the infection returned multiple times before surgery could be scheduled. And when JAMA articles suggest that the survival rate of treating this pathogen is only 25%, you take the antibiotics.

Science is just starting to discover how the body as an ecosystem functions. We still have a lot of progress to make from wiping out all bacteria and relying on broad-spectrum antibodies.

The amazing thing about the bacterial ecosystem is how even different parts of your skin can be colonized by completely different types of bacteria, even just a few inches apart. There are symbiotic relationships just among the bacteria, and other bacteria which are several degrees removed from directly relying on our host bodies. It's a fascinating area of study, but one which is difficult, because it's impossible to isolate and study the bugs individually.

In regards to why anyone would need a shit transplant, I willfully remain ignorant. According to legend, there's a version of fecal transplant called a Happy Meal, which comes with free bread and sauce and a nice bag with some plastic item or something in it. It's said to be safe for children, but I'm no expert.

Hell, so it really is an actual treatment. I would never have surmised it. Pardon the crassness in the first sentence of my original comment, but it seemed ludicrous at first. Inadvertent education,..who'd a thunk it.

Rather than further mod you to oblivion, I chose to leave both your initial reply, where you admit to willfully remaining ignorant on something you dismiss, and the followup where you actually admit to learn something.

You almost sound like a creepy control freak. From my initial impression, I envisioned you having a new pair of trousers reserved for every set of mod-points you receive. Maybe you have a grudge for some reason, in which case I would recommend from experience "a mirror" as the best therapist. But that is probably my imagination getting carried away, so I dismiss it entirely and offer you the following instead:
Regarding the dismissal of information, the comment was jocular; it was the wording, e.g. "Fecal

We had a son that was born at 23 weeks/0 days. Yea, that is 4 months premature. At this time (he turns 4 in December) the biggest problem he has is chronic issues with his gut. The odds are that he never got the correct mix of bacteria in his gut early on, because he was in a sterile environment when his body should have been getting mama milk and the crap that goes along with it.;)

I remember encountering some research strongly supporting pre-biotics over pro-biotics. From my own experience, a blend of the two can be very effective. "Pro-biotics" are things such as kefir, sauerkraut, kimchi, strains like lactobacillus, etc.
"Pre-biotics" are, for example, raw garlic, raw onions, raw leeks, certain bitter raw leaves and so on. Kimchi seems to fit both profiles, to me, especially if made with green onions. When both are included in a regimented diet, a lot can happen. Another factor in

Why don't You give him an enema with tiny bit of Your feces dissolved in (salt) water, about 0.1 - 0.2 liter. If You are healthy and have a good stomach health of course.Normally the babies gets these bacterias at birth from the mothers (unvoluntary) released feces. Unfortunately the idea of totally antiseptic birth have caused many of these problems.

And it has been used medically in treatments for ages, I actually fail to see what is really that new with this(especially since the mouse microbiota is so fundamentally diffent from the human's), albeit it interesting.In this context it means that introducing a new bacteria to the gut microbiota that consumes a certain resource, starves other bacteria that lives on that resource.It is very useful, as literally hundreds of studies show.

Reading is one thing, comprehending is another. For the first time, we know what can get rid of this very bad bug in a mammal, without using the previously accepted (and not at all controversial) fecal transplant when other antibiotics fail.

Mouse or not, this gives a target to look for in humans. And assuming all of the ingredients are human-compatible, this should result in a good step towards curing a very painful and debilitating condition.

All what's needed is the patient making their own, home-made goat kefir (if they're not terribly allergic to dairy -- although even dairy allergies are a para-symptom of wheat allergy in reality). Kefir's 43 different bacteria and yeasts can kill CDiff, and it's being shown to do so in research (Minnesota university professor/doctor tried it recently too). But the kefir must be home-made (bottled ones don't include the full spectrum of bacteria/yeasts because of bottling regulations regarding alcohol the yeasts create), it must be from goat, sheep or buffalo milk (for less casein irritation, as the A2 casein is more compatible with humans), and it must be fermented for 24 hours (to minimize the amount of lactose ingested). Two-three cups a day of kefir (with a few berries in it, maybe with some pine and walnut nuts, also maybe with some raw, unfiltered and local honey too), and CDiff should be back in check within 3-4 days. No need for antibiotics, for pill probiotics, or doctors for that matter.

I've heard nothing but good things about Kefir.
If I didn't travel as much I'd be trying home made Kefir, but some days I just just want to take a pill.
So your plan A:
1) Acquire goat, sheep or buffalo milk.
1.5) Acquire Kefir starter culture (I think you left this step out based on what I've read: "For more information on the starter culture," [kefir.net]).
2) Ferment for 24 hours
3) Drink 3x day
4) CDiff gone.

A common and largely incorrect sentiment suggesting you just have never bothered to think it through all the way. The brilliant realization that drove bottled water out of the original, much smaller Evian market (remember all those hipster T-shirts from the 90's that spelled it backward?) and into the world of Dasani (which is merely the filtered water used by your local Coca-Cola bottler) was that water is widely available for free, but cold water that you can carry with you was not. You could, of course, choose to carry your own water bottle, which many people do when going to the gym or other predictable activity, but on a long journey this is not a good solution. You might choose to carry a cooler and fill it with ice and a few bottles of cold water that you would refill at leisure, if traveling by car, but even then that's a lot of work (and if you have to replenish ice, a bag is likely to cost more than several liters of water, especially if you get the cheaper brands). If traveling by air, bottles of chilled water are nearly the only method to achieve this goal (due to the restrictions on liquids). And if you're flying somewhere, why worry about the tiny additional cost of a couple of bottles of water compared to the hundreds of dollars you spent to get there?

The same logic explains why a two liter bottle of soda at room temperature sells for the same price as a chilled half-liter bottle of the same stuff in a gas station. You are mostly paying for portability (i.e., it fits in your car cupholder) and chilling, not the liquid inside. You can get a better deal by buying fountain drinks, but they go flat faster and have a much higher risk of spill than a bottle with a screw-on cap.

Soda is a little like juice - it's water that has some flavor, except it has a long shelf life and an easily identifiable freshness indicator - if the bottle was opened too long ago, it's pretty much guaranteed to be flat. Any still-carbonated cola is likely to be safe to drink from a microbial standpoint.

Plain carbonated water is less bad for you, and provides the same freshness indicator, but many people do not like the taste that carbonation imparts on its own.

Also, I am not sure why people single out bottled water. Ever looked at the ingredients of bottled soda? It's just water that has been made bad for you.

The criticism against bottled water is that these companies are literally selling something that is all around us in nature, and falls from the sky and (once you've dug a well at least) comes out of the ground for free. Soda, on the other hand, is a man-made product, so selling it seems more justifiable to people. Paying for bottled water would be like payin

"I have no idea what I'm taking about, and I was in too much of a rush to First-Post so I did not bother to read the article. But I made an anti-American remark, and I was snotty, therefore, I'm an instant Slashdot expert! Modded up to 'insightful'".

What sort of fools modded this up?

By the way, if you had bothered to read the article, the research is at the Wellcome Trust Sanger Institute. In the UK. That's not in the US, that's across the Atlantic Ocean, way on the other side.

That article compares workers to workers, not the countries' populations as a whole. How is the higher productivity of each American worker offset by the huge number of Americans who are, for example, either unemployed (7.8% [bls.gov]), on welfare or some other entitlement program (21.8% [heritage.org] for federal programs alone), or engage in non-wealth-producing labor such as working for the government (4% [answers.com])? (Obviously some of those categories overlap so you can't just add them together.)

If you're so productive you'd be able to work fewer hours, rather than having to work more. And those stats only work if you assume that GDP is entirely a function of the productivity of the worker. If that were the case there'd be a stronger link between GDP per worker and income.

If one is productive, one can choose to work fewer hours and do the same amount of work, or work more hours and accomplish more. They are not mutually exclusive, and only a lazy person would choose to work fewer hours.

American workers stay longer in the office, at the factory or on the farm than their counterparts in Europe and most other rich nations, and they produce more per person over the year.

Both are true.

And the link between GDP and income is non-existent. No one has to to be paid more because they

Kefir is even better, but hard to monetize so it's less common. Get some, keep a large jar and replenish with milk as required.

It didn't cross your mind that if you were actually correct, the researcher - who is presumably at least reasonably competent inside the field in which they are working - would have been culturing the microbes from yoghurt or kefir?

Right now, the evidence provided means the 'yoghurt or kefir are just as good' claim carries as much weight as the claim that homeopathic vaccines are as effective as real vaccines.

This research doesn't show the only way or all the ways your gut flora can be restored after (treating) a C dif infection. It describes one way and proves its claim without ruling any other treatments out. Put another way, this research does not disprove the effectiveness of any rememdies not explicitly covered and should not be assumed to evaluate their individual effectivenesses.

The key idea is intentionally augmenting the gut's flora with probiotics so that restoration of beneficial native flora can occu

This research doesn't show the only way or all the ways your gut flora can be restored after (treating) a C dif infection.

Yes indeed.

Put another way, this research does not disprove the effectiveness of any rememdies not explicitly covered and should not be assumed to evaluate their individual effectivenesses.

Also true.

The key idea is intentionally augmenting the gut's flora with probiotics so that restoration of beneficial native flora can occur more rapidly. The paper points to specific strains which are required to attain the effectiveness of a fecal transfer. L bacillus and acidophilus may not cure your C dif infection or instantly restore homeostasis, but they'll significantly help restore your ability to properly receive nutrients from digested food. While more palatable than eating poo, they're simply not as efffective because they don't represent all the necessary flora. They are, however, still effective and recommended as treatments.

And I still am not disagreeing with you here - and indeed neither does my original post.

While theirs was not an accurate or well supported claim, please recognize that the comment you responded to contained more truth than your dissmissively out of hand rebuttal. Also, don't try to appeal to authority when there is evidence against your assertion that probiotics are equivalent to homeopathy.

And here, you're incorrect. They actually contain a claim, with no supporting evidence.Yoghurt and Kefir may indeed be good for gut flora, but claiming that Yoghurt and Kefir do the same thing as a fecal transplant, but are n

(Google traduction)"On primary prevention, in a recent double-blind presented American College of Gastroenterology where 44 patients who had a yogurt enriched lactobacilli were compared with 45 patients with placebo, the incidence of diarrhea was significantly lower in the group with probiotic (p = 0.01). However, in view specifically of diarrhea associated with Clostridium difficile, the difference between the groups was less significant (1 patient in the probiotic group vs 7 in the placebo group had an episode of CDAD, p = 0.058)."

I agree, and I didn't say that yoghurt efficiency (did you mean efficacy?) is a homeopathic lie. I said that the evidence provided (meaning by the previous posters) meant that their claim carried as much weight as the claim that homeopathic vaccines are as effective as real vaccines.

Just to make sure I'm very clear (because others also took a different meaning from my post than I intended):The evidence provided for claim X means that the claim carries as much weight as claim Y.That doesn't mean X is an exam

Eating yogurt is not a homeopathic remedy. Look up what homeopathic means.

Eating yogurt is a simple treatment, and as the grandparent's quote indicates it is significantly effective at reducing the incidence of diarrhea in cases of gut flora loss (due to antibiotics usually). However, it is significantly less effective when the problem is specifically c.difficile overgrowth.

So if you're taking antibiotics, get a probiotic yogurt, it is likely to help. If you do end up with c. diff, you may need another type of treatment.

Couple of notes here. This is purely anecdotal so don't take it as the Gospel. I was on IV antibiotics not too long ago followed by oral antibiotic for a condition called Diverticulitis.

Anyways, while I was on the antibiotic, I wasn't to have milk or milk based foods (yogurt, ice cream so on). I was told it would reduce the effectiveness of the antibiotic and the treatment wouldn't work. After I finished the oral antibiotics, I was instructed to drink at least 2 ounces of kefir at least twice a day by my do

So you just spent three sentences claiming yogurt will cure c.difficile, arguing the parents point is incorrect.Then your final sentence claims yogurt will NOT cure c.difficile, echoing exactly the parents point.

Your first three sentences also link in with the parent being wrong as you claim homeopathic remedies are somehow scientific and do work, since that was that posts entire point...

Also no one at all in this thread claimed yogurt was homeopathic, that was just something you made up (likely on purpose)

I buy it in the health food section about once a week. Please explain because I would love to have it more often but at $5 a quart, I think a quart a week is enough. on the other hand, I go through about a gallon and a half of milk a week.

Kefir is easy to make, once you have a starting culture. Just drop a glob of the starting "seed" into milk. Leave out overnight away from heat or sunlight. The Kefir will eat all the milk and give you a big jar of Kefir. Run the Kefir through a strainer. Drink the liquid. Put the solids back into the jar with new milk. Repeat daily.

I'm not sure if the store bought Kefir still has live culture in it. I got mine from a friend who got it from a friend etc. Been drinking it for years from that one starter "seed

Eating yogurt is the same as "intake of a healthy person's fecal matter?"

Source, please.

It's not the same. It only contains one of the species of common intestinal bacteria that keep your gut happy. But sometimes just reestablishing a colony of that one is enough to help a lot with intestinal problems.

Yogurt does help create a healthy gut flora, but yogurt contains only a few, at most, of the bacteria that the intestine needs to operate normally. Your gut naturally contains E. Coli, and Enterococcus, neither of which you want to get from the grocery store.

And, if it weren't for your large intestine filtering out most of the water, then when you drank milk you would excrete something similar to yogurt.

Reporting in Science Translational Medicine, researchers write that the bacteria in yogurt affect people’s digestion--but not by repopulating gut flora. Microbiologist Jeffrey Gordon talks about these findings and the future of using bacteria as therapy for dig

I would never ever wish C-Diff on anyone, not even my worst enemy. After the wife was put on broad spectrum antibiotics for an ear infection, then came what we thought was a bit of the flu or stomach virus (a.k.a. the trotts). Never-ending trotts. After exploratory colonoscopy & cultures to verify, & several different rounds of antibiotics, what finally worked for us was one last round of antibiotics combined with an insane intake of yogurt & probiotics (as we were finishing off the antibiotics). I think it was the combination that worked for us. We now start a (paranoid) regimen of yogurt & pro-biotics whenever someone is on antibiotics. Would we have gone for the "shit enema" (as unappealing as that sounds)? Perhaps. Let me put it this way, after weeks of the most debilitating pain (doubled over in pain), not eating for days, and blood literally pouring out your hind end, you are ready to grasp at anything that might work. Wife said that child birth had nothing on the C-Diff pains (& she went through 2 births with not so much as an aspirin -- another story. ..). I'll joke about a lot of things, but not this. So if this works (faster), more power to it. Oh yeah, cases of C-Diff are on the rise -- yay ( http://www.health.harvard.edu/newsletters/Harvard_Mens_Health_Watch/2010/June/clostridium-difficile-an-intestinal-infection-on-the-rise [harvard.edu] & http://www.npr.org/blogs/health/2012/03/06/148072242/deaths-from-dangerous-gut-bacteria-hit-historic-highs [npr.org] ).

It's not inserted into the stomach. Whoever wrote that doesn't know what the hell he's talking about, or is listening to someone who doesn't know what he's talking about. It's inserted into the small bowel via the colon using the same equipment used in colonoscopies.
And it's not controversial. If you have C. diff, you are suffering so horribly that grossness of the procedure just doesn't enter the equation. And the fecal transplant method is incredibly effective, and incredibly quick to solve the problem. People who have been in agony for weeks get so much better in a few hours they can be discharged from the hospital. The only issue is that fecal transplants aren't yet covered by insurance. But they aren't that expensive, less than a grand out of pocket.

The only issue is that fecal transplants aren't yet covered by insurance.

This, and the fact that it may just be a temporary cure if the patient has a weak immunity: the same cause may make the same effects.

This may be true, but does your gut really get affected that much by your immune system? I know it does it various auto-immune diseases but that is the opposite to what you are describing. From what i've read the balance of bacteria in your gut is supposed to regulate itself but the bad bacteria can move in after the patient has had a heavy does of antibiotics to treat other infections.

Unless you were implying that the weak immunity requires heavy doses of antibiotics to treat recurring infections? I guess

Generally, the root cause of a C. Diff infection is the course of antibiotics given to the the patient to treat another ailment. Once the course has concluded the normal diversity of gut flora is no longer present and the opportunity for C. Diff to overpopulate the gut arises. C. Diff is resistant to most antibiotics due to having a cyst phase in its life cycle that enables the bacteria to live on surfaces outside the bowel. Treatment with certain antibiotics including Flagyl or Vancomyacin may kill the C. Diff bacteria in the bowel but will also kill any other resident gut flora at the same time. If the patient comes in contact with C. Diff immediately following this second antibiotic course the infection will likely return. Often the physician will recommend live culture yogurt and other probiotics be ingested even during the C. Diff antibiotic treatment to promote a diversity of gut flora the moment the antibiotics are discontinued. This is not always successful and the treatment may have to repeated several times.

Wow, wait a second here! If you take probiotics such as yogurt while there are still antibiotics in your body, some of the probiotic bacteria are likely to evolve full or partial resistance and that increases the chance of passing that resistance to pathogenic bacteria entering the gut later through horizontal gene transfer. It seems intellectually lazy that you are discounting this serious risk!

I'm sure you realize that the pathogenic bacteria in question is C.Diff and a different species (and genus) from the beneficial bacteria supplied by the probiotic supplement/diet and they will never interact genetically.

It is the imbalance not the presence of these organisms that causes problems. E. Colli is another common troublemaker that lives in all of our bowels but is more easily dealt with than C. Diff. While some resistance to antibiotics *might* manifest, that resistance will be lost as the indiv

People who have been in agony for weeks get so much better in a few hours they can be discharged from the hospital. The only issue is that fecal transplants aren't yet covered by insurance.

That should be a pretty easy decision to make though... hospital stays aren't cheap (and I assume are covered by insurance in the US?) and a decent infection of clostridium difficile can kill you and make you very expensive to take care of while you die.

Enteric coatings are designed to release in the small intestine, whereas C diff lives in the colon. According to some conversations which a doctor I work with (who primarily focuses on C diff), it is difficult to get a pill that lasts until the colon, dissolves there, and has enough content of whatever treatment method you're trying.

When it's done by feeding tube, it is released into the small intestine, not the colon (presumably it migrates down and colonizes). Otherwise an enema can be used and it migrates up. Surely, unless the feeding tube has already been placed for other reasons, there's no good reason to make the patient pay through the nose (pun intended).

These are also performed via upper rather than lower endoscopy, with the gastroscope passed via the mouth and past the stomach into the small bowel, for the reason that a simple enema has an unacceptably high risk of being expelled before it can take root - these people are suffering from massive diarrhea, after all. That's how the GI docs I know do it. It's a simple procedure whose major risk is the yuck factor.